Healthcare Provider Details

I. General information

NPI: 1225001134
Provider Name (Legal Business Name): IVANA K. HRSTIC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WEST END AVENUE SUITE 102
NASHVILLE TN
37203-1405
US

IV. Provider business mailing address

1800 WEST END AVENUE SUITE 102
NASHVILLE TN
37203-1405
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4904
  • Fax: 615-320-5836
Mailing address:
  • Phone: 615-327-4904
  • Fax: 615-320-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8146
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: